COUNTRYSIDE HOME - JEFFERSON, WI

United States hospital / nursing home:
COUNTRYSIDE HOME - JEFFERSON, WI

COUNTRYSIDE HOME
1425 WISCONSIN DR
JEFFERSON, WI 53549


RELIGIOUS NONMEDICAL HEALTH CARE INSTITUTIONS SNF/NF (DISTINCT PART)

Services provided by COUNTRYSIDE HOME:

  • Activities services are provided onsite to residents
  • Dental services are provided onsite to residents
  • Dietary services are provided onsite to residents
  • Housekeeping services are provided onsite to residents
  • Mental health services are provided onsite to residents
  • Nursing services are provided onsite to residents
  • Occupational therapy services are provided onsite to residents
  • Field 1 - Indicates other activity services provided by staff onsite to residents
  • Pharmacy services are provided onsite to residents
  • Physician extender services are provided onsite to residents
  • Physical therapy services are provided onsite to residents
  • Physician services are provided onsite to residents
  • Podiatry services are provided onsite to residents
  • Social work services are provided onsite to residents
  • Speech/language pathology services are provided onsite to residents
  • Therapeutic recreation specialist services are provided onsite to residents
  • Diagnostic xray services are provided onsite to residents

Beds - Total (Total number of beds in a facility, including those in non-Participating or non-licensed areas): 206

Beds - Total certified (Number of beds in Medicare and/or Medicaid certified areas within a facility): 206

Beds - Nursing facility (Number of Medicaid certified skilled nursing care beds in a facility): 104

Lpn/lvn - Full time (The number of full-time equivalent licensed practical/ vocational nurses employed by a facility on a full time basis): 15.36

Registered nurse - Full time (The number of full-time equivalent registered nurses employed by a facility on a full time basis): 6.69

Compliance: life safety code (Indicates if a waiver of the life safety code has been recommended for a provider): WAIVER RECOMMENDED

Program participation (Indicates if the provider participates in Medicare, Medicaid, or both programs): MEDICARE AND MEDICAID

Regional override #1 (number beds) (This field is set to "y" when the regional office has to ok a pending record in the special fields screen. this field only applies to categories in the odie data entry system): Yes

Regional override #2 (staffing) (This field is set to "y" when the regional office has to ok a pending record in the special fields screen. this field only applies to categories in the odie data entry system): Yes

Activity professional - Full time (The number of full-time equivalent activities professionals employed full time by a facility): 1.07

Administrator - Full time (The number of full-time equivalent administrative staff employed on a full time basis by a facility): 14.16

Administrator - Part time (The number of full-time equivalent administrative staff employed on a part-time basis by a facility): 2.10

Beds - Snf/nf (Number of beds certified for both Medicare and Medicaid skilled nursing care in a long term care facility): 102

Cert nurse aides - Contract (The number of full-time equivalent certified nurse aides under contract to a facility): 6.76

Cert nurse aides - Full time (The number of full-time equivalent certified nurse aides employed by a facility on a full time basis): 47.57

Cert nurse aides - Part time (The number of full-time equivalent certified nurse aides employed by a facility on a part time basis): 24.70

Dentists - Contract (The number of full-time equivalent dentists under contract to a facility): 0.36

Dietitians - Part time (The number of full-time equivalent dietitians employed by a facility on a part time basis): 0.86

Food service - Full time (The number of full-time equivalent food service personnel employed by a facility on a full time basis): 10.23

Food service - Part time (The number of full-time equivalent food service personnel employed by a facility on a part time basis): 12.64

Housekeeping - Full time (The number of full-time equivalent housekeeping personnel employed by a facility on a full time basis): 20.61

Housekeeping - Part time (The number of full-time equivalent housekeeping personnel employed by a facility on a part time basis): 5.27

Lpn/lvn - Contract (The number of full-time equivalent licensed practical/ vocational nurses under contract to a facility): 9.46

Lpn/lvn - Part time (The number of full-time equivalent licensed practical/ vocational nurses employed by a facility on a part time basis): 6.21

Medical director - Contract (The number of full-time equivalent medical directors under contrcat to a facility): 0.11

Mental health services - Contract (The number of full-time equivalent mental health services personnel under contract to a facility): 0.71

Nurses with admin duties-Full time (The number of full-time equivalent nurses with administrative duties employed by a facility on a full time basis): 2.09

Occup therapy asst - Contract (The number of full time equivalent occupational therapy assistants under contrcat to a facility): 0.73

Occupational therapist - Contract (The number of full-time equivalent occupational therapists under contract to a facility): 0.54

Organized resident group (Indicates if the facility has an organized residents group): Yes

Other - Full time (The number of full-time equivalent persons not included in any other categories employed by the facility on a full-time basis): 10.74

Other - Part time (The number of full-time equivalent persons not included in any other categories employed by the facility on a part-time basis): 3.47

Other activities staff-Full time (Number of full-time staff hours for other activities): 3.23

Other activities staff-Part time (Number of part time staff hours provided by other activ ities staff): 1.49

Other physician - Contract (The number of full-time equivalent other physicians under contract to a facility): 0.11

Pharmacists - Contract (The number of full-time equivalent pharmacists under contract to a facility): 0.23

Phys ther asst - Contract (Number of contract staff hours for physical therapy ass istants): 1.01

Physical therapists - Contract (The number of full-time equivalent physical therapists under contract to a facility): 0.49

Physical therapy aide - Contract (The number of full-time equivalent physical therapy aide under contract to a facility): 0.83

Registered nurse - Part time (The number of full-time equivalent registered nurses employed by a facility on a part time basis): 2.70

Rn director of nursing - Full time (The number of full-time equivalent rn director of nursing employed by a facility on a full time basis): 1.13

Social worker - Full time (The number of full-time equivalent social workers employed by a facility on a full time basis): 2.76

Speech pathologist - Contract (The number of full-time equivalent speech pathologists under contract to a facility): 0.50

Compliance: status (Indicates if a provider or supplier is in compliance with program requirements): IN COMPLIANCE

Current survey date (The date of the health or life safety code survey, whichever is later. the "official" survey date for the provider): Oct 2002

Eligibility code (Indicates if a facility is eligible to participate in the Medicare and/or Medicaid programs): ELIGIBLE TO PARTICIPATE

Participation date (The date a facility is first approved to provide Medicare and/or Medicaid services): Mar 1978